Grief and loss
Grief and loss are deeply painful experiences, yet they are experiences nearly everyone will have to face at some point. Most people experience a certain grieving process, characterized by specific feelings and behaviors, but there is no universal way of experiencing grief (Howarth, 2011). Find out more about grief and loss as processes, below.
Grief and loss: some definitions
Uncomplicated bereavement is when we experience the loss of a loved one in what is defined as a normal way, through sadness, anger, insomnia, and other symptoms. In uncomplicated bereavement, the person is able to achieve different tasks, such as accepting the reality of the death of the loved one, experiencing the pain, adjusting to life without the person, changing the relationship with the lost loved one, finding meaning in the death, and other tasks. When the person is able to reconcile with the death, they can experience a “normal” bereavement process that also might be affected by cultural and individual factors. When people can’t accomplish these tasks successfully, they might experience a complicated grief process (Howarth, 2011).
A complicated grief is when the person doesn’t reach the resolution and their bereavement process is interrupted. The person might develop trauma symptoms associated with grief. The person might continue to experience extreme distress, as they felt when they first felt the loss. People might feel extreme focus on the loss, difficulties accepting it, numbness or detachment, irritability, withdrawal, an inability to deal with the loss or reminders of the loss, and other symptoms that may in some cases be similar to the symptoms of post-traumatic stress disorder. Bereveament and grief can be normal processes, but if they lead to extreme symptoms or become chronic, something might not be going right (Howarth, 2011).
There is a variety of risk factors for complicated grief. Some of these include being female, having experienced preexisting trauma, especially childhood trauma, prior loss, prior mood and anxiety disorders, being in the role of caretaker for the deceased, such as being the caretaker of a child or chronically ill adult. The nature of the death also plays a role as violent, sudden, prolonged, or suicide-related deaths are more likely to lead to a complicated grief. Other factors like lack of available resources, lack of information about the death, substance abuse, the inability to engage in cultural rituals or processes of death and mourning, and lack of social support are all risk factors.
Complicated grief can be identified clinically, as it is characterized by being out of proportion and involving a high distress persisting for at least 12 months after the loss. Around 7% of all individuals who are bereaved might experience complicated grief. Complicated grief can appear together with other disorders, such as depression and post-traumatic stress disorder. It also might put the individual at risk for suicide. People who are bereaved might benefit from an assessment for complicated grief and being treated for it, especially if they are experiencing co-occurring disorders. One of the proposed treatments for grief is anti-depressants (Simon, 2013).
So, grief is something all people are likely to experience at some point, at multiple times. While most people can overcome grief on their own, some struggle with it for a long period of time. This has led to the development of therapeutic interventions for grief. But do these interventions work (Neimeyer & Currier, 2009)?
Grief and loss: what types of interventions are available?
When compared, it could be said that interventions for grief could be divided in three types. Universal interventions targeted everyone suffering from grief, selective interventions targeted people with a high risk situation (like parents who had lost a child), and indicated interventions assessed whether there were difficulties dealing with grief before the treatment. Out of the three, only indicated interventions showed benefits that were maintained over time. Grief therapy can offer a relief of distress for individuals who have a hard time coping on their own. Specific forms of therapy that target complicated grief, such as complicated grief therapy, have been shown to produce good results in the short term and the long term, reducing an individual’s distress and helping them deal with the symptoms of complicated grief. However, it would seem that many or most people are able to work through the grief on their own, showing an impressive capacity for resilience. Often, the key process in working through grief is through finding meaning or making meaning, as the death of a loved one might challenge the process of making meaning (Neimeyer & Currier, 2009).
One perspective on grief is the constructivist perspective that offers various tools for working with grief. This perspective suggests that the person needs to create meaningful narratives that help them find meaning and that people hold core beliefs about the world that give them a framework to understand the world. For example, people might see the world as being good. A death, especially a painful or sudden death, can challenge those beliefs and narratives. For example, a person whose partner has passed away suddenly might feel the world is not a good, but a dangerous, unpredictable place. A person who struggles with grief struggles to integrate the death into their personal narrative and set of beliefs (Neimeyer, Burke, Mackay, & Van Dyke Stringer, 2010).
The first process bereaved individuals engage in is the search for meaning in death. If the person can find meaning, they usually cope better with the loss. Therapeutic interventions aimed at finding meaning can help individuals cope better with the death of a loved one. These interventions include techniques like therapeutic retelling, where the person seeks to narrate their experience with the loss coherently and feel validated in feeling what they have felt, therapeutic writing, where the person is encouraged to write about their experiences in different ways, visualization, where the person tries to experience the metaphors they associate with grief and visualize them vividly to work with them in therapy and use them to find meaning, and a pro-symptom position, where the person is encouraged to explore their symptoms and acknowledge them as necessary to later help them change (Neimeyer, Burke, Mackay, & Van Dyke Stringer, 2010).
Grief and loss resources
Howarth, R. A. (2011). Concepts and Controversies in Grief and Loss. Journal of Mental Health Counseling, 33(I), 4–10. http://doi.org/10.1080/07481187.2011.584013
Neimeyer, R. A., Burke, L. A., Mackay, M. M., & Van Dyke Stringer, J. G. (2010). Grief therapy and the reconstruction of meaning: From principles to practice. Journal of Contemporary Psychotherapy, 40(2), 73–83. http://doi.org/10.1007/s10879-009-9135-3
Neimeyer, R. & Currier, J.M. (2009). Grief Therapy. Evidence of Efficacy and Emerging Directions. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 18(6), 352–357.
Simon, N. M. (2013). Treating complicated grief. JAMA: The Journal of the American Medical Association, 310(4), 416–423. http://doi.org/10.1001/jama.2013.8614